The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time

by Alex Korb

Worrying has that same feature but is colored with more negative emotions. Worrying worsens your mood, and when your mood is worse, you worry more, which is a classic downward spiral.4

The difference between the two groups was simply that the people with anxiety problems got stuck in their worrying. Essentially, the communication circuit between the prefrontal cortex and anterior cingulate got stuck in the “on” position.

that when the limbic system is overactive, it’s like turning up the volume of your negative emotions.

When you’re in a negative mood, almost all outcomes that your prefrontal cortex can calculate are tinged with a bit of negativity.

“My life has been full of terrible misfortunes, most of which never happened.”

Worrying and anxiety are distinct but related concepts—you can have worrying without anxiety and anxiety without worrying.

In essence, worrying is thinking about a potential problem, and anxiety is feeling it.

Feeling in control reduces anxiety, worrying, and even

pain.7 These effects are mediated by the dorsolateral prefrontal cortex, so strengthening dorsolateral activity helps create an upward spiral.

by simply paying more attention to what is in your control, which helps modulate your brain activity...

As we briefly discussed above, anxiety depends on activation of the fear circuit—the same neural circuitry that keeps us out of danger. Fear activates the body’s stress response, readying you to either face the danger or run from it.

Taking a slow, deep breath—inhaling and then exhaling slowly—actually calms down the sympathetic nervous system and reduces stress

The difference is between actual danger and potential danger. Fear is a response to actual danger that is right here, right now, while anxiety is concern for events that only might happen—events that may be unpredictable and that you may lack control over.

and while this may seem unfortunate, the sensitivity of the limbic system is actually one of its greatest evolutionary advantages.

Go for good enough. Worrying is often triggered by wanting to make the perfect choice or by trying to maximize everything.

If you try to have the best of everything, you’re likely to be paralyzed by indecision or dissatisfied with your choice. In fact, this kind of “maximizing” has been proven to increase depression.9 So don’t try to make the most amazing dinner; start

Don’t try to be your happiest; just be happy.

Anxiety doesn’t always have a conscious, thinking component; it can simply be a sensation, like an upset stomach or shortness of breath.

So don’t get too upset with yourself for being anxious. Your brain is trying to help you.

Unfortunately, the specific tendencies of your anxiety and worrying circuits sometimes interfere with your ability to be happy.

The problem is only that these circuits might activate too frequently or might interact with each other to keep you stuck. Fortunately, recognizing how your brain works is a key step toward mindfulness and ...

“A” stands for “alarm.” You make an observation that something seems wrong (for example, My heart is racing or That tuft of grass seems to be shaking strangely).

“B” stands for “belief.” You evaluate the alarm and create a belief about the observation you just made (I’m having a heart attack or There’s a lion in the grass). The beliefs are often subconscious; you’re not even aware of them. The limbic system deals with unconscious beliefs,

What happens next determines whether it will all devolve into a downward spiral or not.

Avoid catastrophizing. Anxiety is exacerbated by envisioning the worst possible scenario—a process known as “catastrophizing”

It usually starts with a perfectly reasonable worry, and then, through an incorrect assumption, it snowballs out of control.

First, remind yourself of the more likely (and better) outcomes (“Maybe my friend is busy right now”). Second, whether or not the worst-case scenario is actually likely, make a plan to deal with it

Planning your response to stressful situations can increase prefrontal norepinephrine, and calm the limbic system, helping you feel more in control.12

“C” stands for “coping.” Coping is whatever you do after the belief. Do you take a deep breath and tell yourself everything will be okay? Do you freak out? Yes, freaking out is a form of coping.

if all these productive forms of coping were already part of your habit circuit, you probably wouldn’t have a problem with anxiety.

The first step is simply to recognize your anxiety or worrying when it occurs. Becoming aware of your emotional state activates the prefrontal cortex and allows it to suppress the amygdala.

“Putting Feelings into Words,”

reduced the emotional amygdala reactivity.13 In other words, consciously recognizing the emotions reduced their impact.

because you can’t fix something you don’t know is there.

one of the most common ways people cope with anxiety is by worrying about it.

Furthermore, we often have anxiety about one thing, but worry about something else.

Stay in the now. Pay attention to the things that are happening now, and don’t pay attention to the things that aren’t happening now.

Attention to the present also increases dorsolateral and ventrolateral prefrontal activity, allowing these regions to calm the amygdala.15 Improving your ability to stay present, a practice known as “mindfulness,” helps enhance these activations and leads to long-term improvements in anxiety and worrying.

Putting emotions into words—however hokey that sounds—actually rewires your brain circuits and makes you feel better.

Shift your focus to what’s occurring right now. This is why Buddhist monks and yogis practice nonjudgmental awareness—the process of being aware of the present, without attaching emotional reactivity to it. This mindfulness practice cuts off worry and anxiety at the source.

But often I can cut it off by simply taking a deep breath, reminding myself that it will all turn out okay—or that if it doesn’t, a ruined dinner party is hardly the end of the world—and then I go back to chopping broccoli.

You have a circuit in your brain that helps decide what to pay attention to and what to ignore. This attention circuit is influenced by the emotion circuit, so our brains are wired to pay more attention to emotional events.

Interestingly, our emotion circuits are more easily activated by the negative,

most people need to experience numerous positive events for every one negative just to come out even.

Their brains are biased toward pain, loss, and the emotional toll of mistakes, and they often distort memories of the past and expectations of the future. In depression, the brain’s negative bias is responsible for making bad situations seem a lot worse than they actually are.

the circuit for paying attention influences the circuit for emotion, and vice versa.2 And while this is true of every human’s brain, it is more exaggerated in people with depression, even in people at risk for depression.

The amygdala’s response to emotion is not under conscious control.

This demonstrates that you do not have full control over your brain’s automatic emotional response, but you do have some control.

The dorsal anterior cingulate pays particular attention to pain,4 to mistakes you make,5 or to times when it thinks something might go wrong.6 In short, it provides reasons for the amygdala to freak out.

Depressed people are more likely to believe friends are frowning at them, mocking them, or ignoring them—even when they aren’t. It’s easy to see how the downward spiral starts from there.